Provider Demographics
NPI:1255825832
Name:SKAUG, SHANNON LOUETTE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LOUETTE
Last Name:SKAUG
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2000
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-2000
Mailing Address - Country:US
Mailing Address - Phone:910-235-2709
Mailing Address - Fax:910-215-3080
Practice Address - Street 1:5 FIRST VILLAGE DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9495
Practice Address - Country:US
Practice Address - Phone:910-235-2709
Practice Address - Fax:910-215-3080
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013285363LF0000X
AL1-153334363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily